This Week in JAMAFREE

OXYGEN SATURATION AND EXTREMELY PRETERM INFANTS

In a multicenter randomized trial that involved 1201 extremely preterm infants who were assigned to an oxygen therapy target of either 85% to 89% or 91% to 95% arterial oxygen saturation, Schmidt and colleagues found that targeting lower compared with higher oxygen saturations had no significant effect on the rate of death or disability at 18 months. In an editorial, Bancalari and Claure discuss oxygenation targets and outcomes in preterm infants.

TIMING OF TRACHEOSTOMY IN MECHANICAL VENTILATION

Young and colleagues examined the effect of early (within 4 days) vs late (after 10 days) tracheostomy in a multicenter randomized trial that enrolled 909 adult patients who had been mechanically ventilated for less than 4 days and were expected to require at least 7 additional days of ventilation. The authors report that tracheostomy within 4 days of initiating mechanical ventilation was not associated with improved 30-day mortality, the primary trial end point. In an editorial, Angus discusses the challenge of knowing when a mechanically ventilated patient should undergo tracheostomy.

EARLY PARENTERAL NUTRITION IN CRITICALLY ILL PATIENTS

In a multicenter, randomized trial that enrolled 1372 critically ill adult patients who had relative contraindications to early enteral nutrition, Doig and colleagues found that compared with standard care (mean time to feeding, 2.8 days), provision of early parenteral nutrition (commencing a mean 44 minutes after enrollment) did not alter the 60-day mortality risk, rates of infection, or length of stay, but was associated with fewer days of mechanical ventilation. In an editorial, Ochoa and Machado discuss the contribution of the study findings to an understanding of when and how to feed critically ill patients.

ESCITALOPRAM AND STRESS-INDUCED MYOCARDIAL ISCHEMIA

To examine the effects of pharmacological intervention to reduce mental stress–induced myocardial ischemia, Jiang and colleagues randomly assigned 127 patients with clinically stable coronary heart disease and documented mental stress–induced myocardial ischemia to receive either escitalopram or placebo for 6 weeks. The authors found that compared with placebo, treatment with escitalopram was associated with a lower rate of mental stress–induced myocardial ischemia.

CLINICIAN'S CORNER

Management of Active Crohn Disease

Mr C, a 40-year-old man with Crohn disease, has not achieved a durable remission with several medical therapies. Cheifetz reviews the diagnosis and management of Crohn disease with a focus on newer treatments and goals of care.

JAMA CLINICAL CHALLENGE

A 10-month-old boy with a recent respiratory tract infection presented with erythematous swelling of the ears and perioral macules. Four days later, targetoid, purpuric lesions appeared on his legs. Physical examination was otherwise normal, and urine and blood studies are negative. What would you do next?

A PIECE OF MY MIND

“This man had jumped out of planes in a foreign country wearing a US uniform and he had landed in the American latrine, bundled and broken in a homeless shelter across the street from deluxe condominiums.” From “The Proud Paratrooper.”

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